Can I Change From Medicare Advantage to Medicare Supplement?

Medicare, the federal health insurance program for individuals aged 65 or older and certain younger people with disabilities, offers various choices for receiving coverage. Many individuals initially select a Medicare Advantage (Part C) plan, which is offered by private companies. However, circumstances can change, leading some to consider transitioning to Original Medicare (Parts A and B) and adding a Medicare Supplement (Medigap) plan. This article explores changing from a Medicare Advantage plan to a Medicare Supplement plan, detailing distinctions, enrollment periods, and guaranteed change conditions.

Distinctions Between Medicare Advantage and Medicare Supplement Plans

Medicare Advantage plans, often called Part C, are offered by private insurance companies approved by Medicare. These plans provide all Original Medicare benefits (Part A and Part B), and many include additional benefits such as prescription drug coverage (Part D), vision, dental, and hearing services. Medicare Advantage plans typically operate within their own networks of doctors and hospitals.

In contrast, Medicare Supplement plans, also known as Medigap, are sold by private companies and work in conjunction with Original Medicare. Medigap policies help cover out-of-pocket costs that Original Medicare does not, such as deductibles, copayments, and coinsurance. These plans supplement Original Medicare and do not offer additional benefits like prescription drug coverage, which requires a separate Part D plan. You cannot have both a Medicare Advantage plan and a Medicare Supplement plan at the same time.

Enrollment Periods for Changing Coverage

Individuals changing Medicare coverage, including from a Medicare Advantage plan, must do so during specific enrollment periods. The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During this time, beneficiaries can disenroll from a Medicare Advantage plan and return to Original Medicare, or switch to a different Medicare Advantage plan. Any changes made during the AEP become effective on January 1 of the following year.

The Medicare Advantage Open Enrollment Period (MA OEP) occurs from January 1 to March 31 annually. This period allows individuals already in a Medicare Advantage plan to make a single change: either switch to another Medicare Advantage plan or disenroll from their current plan and return to Original Medicare. If returning to Original Medicare, beneficiaries have an opportunity to enroll in a stand-alone Medicare Part D prescription drug plan during this time.

Special Enrollment Periods (SEPs) allow changes outside standard windows due to specific life events. Examples of qualifying events include moving to a new service area, losing other creditable coverage, or if your Medicare Advantage plan leaves your service area or ends its contract with Medicare. The duration of an SEP varies depending on the qualifying event, typically ranging from two to three months from the date of the event or notification.

Circumstances for Guaranteed Medicare Supplement Enrollment

Acquiring a Medicare Supplement plan outside your initial Medigap Open Enrollment Period can be challenging, often involving medical underwriting. However, “Guaranteed Issue Rights” protect individuals in specific situations, requiring insurance companies to sell a Medigap policy without regard to health status, pre-existing conditions, or gender. These rights ensure that coverage cannot be denied, nor can higher premiums be charged due to health.

One common scenario triggering guaranteed issue rights is “Trial Right 1.” This applies if you joined a Medicare Advantage plan when first eligible for Medicare at age 65 and decide to switch back to Original Medicare within 12 months. Under this right, you can purchase any Medigap policy sold in your state from any insurance company. The application for the Medigap policy must generally be made as early as 60 days before your Medicare Advantage coverage ends, or no later than 63 days after it terminates.

Another protected situation is “Trial Right 2,” which applies if you dropped a Medigap policy to join a Medicare Advantage plan for the first time. If you decide within 12 months that the Medicare Advantage plan does not meet your needs, you can switch back to Original Medicare and regain your previous Medigap policy, if still available, or a similar one. This allows a trial period for the Medicare Advantage plan without permanently losing your ability to return to Medigap coverage.

Other guaranteed issue situations include instances where your Medicare Advantage plan leaves your service area, Medicare ends its contract with your plan, or you move out of the plan’s service area. Additionally, if your Medicare Advantage plan commits fraud, misrepresents information, or if you lose eligibility for your plan, you may also qualify for guaranteed issue rights. In these cases, you typically have 63 days from the date your previous coverage ends to enroll in a Medigap policy.

Process for Transitioning Your Plan

Transitioning from a Medicare Advantage plan to Original Medicare with a Medigap policy involves several steps. First, research the standardized Medigap plans (Plans A through N) available in your area. While all plans of the same letter offer the same basic benefits, prices can vary significantly between insurance companies. Contact multiple insurance companies to compare quotes and understand their specific application requirements.

Once you have identified a suitable Medigap plan, you can submit an application to the chosen insurance company. Unless you qualify for guaranteed issue rights, the application will likely involve answering health questions, as medical underwriting may apply. Await approval and confirmation of your Medigap policy’s effective date before disenrolling from your current Medicare Advantage plan.

After your Medigap policy is approved and effective, disenroll from your Medicare Advantage plan. This can be done by contacting your Medicare Advantage plan directly, calling Medicare at 1-800-MEDICARE, or by enrolling in Original Medicare during an appropriate enrollment period, which automatically disenrolls you from your MA plan. If your new Medigap plan does not include prescription drug coverage, which is common, you will also need to enroll in a stand-alone Medicare Part D prescription drug plan. Ensure all coverage changes are confirmed, verifying your Medigap and Part D plans are active and your Medicare Advantage plan is terminated to avoid gaps or overlaps.